Opinion: ADHD medications lack supporting evidence

July 1, 2008

A reader comments on the lack of supporting evidence for the benefits of ADHD stimulants for children.

Dear Editor,
The article "ADHD: Beyond the meds" by Dr. Michael Jellinek is interesting and informative, and outlines many useful approaches for parents of children diagnosed with ADHD.1 In fact, the tips and pointers are applicable to all children whose parents seek to support their child at school, at home, and in extracurricular activities.

Dr. Jellinek states that the "Multimodal Treatment Study of Children with ADHD ... provided support for current treatment protocols." Actually, the Multimodal Treatment Study (MTA) found no significant difference in outcomes at 36 months for children diagnosed with ADHD, whether treated or not treated with stimulants.2-4

The MTA also found that children who received stimulants, compared to those who did not, showed significant behavioral deterioration between 24 and 36 months and had higher delinquency ratings at 24 and 36 months.2-4 These findings, which are not easily explained, do not support current treatment protocols for ADHD that emphasize the use of stimulant medications.

Dr. Jellinek's practical and creative suggestions offer the possibility that neither a diagnostic label nor stimulant medications are the best way to help children with symptoms of inattention and hyperactivity.

Sincerely, Lydia Furman, MD Rainbow Babies and Children's Hospital Cleveland

References

1. Jellinek M: ADHD: Beyond the meds. Contemp Pediatr 2008;25:39

2. Swanson J, Hinshaw S, Arnold LA, et al: Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. J Am Acad Child Adolesc Psychiatry 2007;46:1003

3. Molina B, Flory K, Hinshaw S, et al: Delinquent behaviour and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects. J Am Acad Child Adolesc Psychiatry 2007;46:1028

4. Jensen P, Arnold E, Swanson J, et al: 3-year follow-up of the NIMH MTA Study. J Am Acad Child Adolesc Psychiatry 2007;46:989